As you are reading this article, there are between eight and
ten million women and girls in the Middle East and in Africa who
are at risk of undergoing one form or another of genital cutting.
In the United States it is estimated that about ten thousand girls
are at risk of this practice. FGC in a variety of its forms is
practiced in Middle Eastern countries (the two Yemens, Saudi Arabia,
Iraq, Jordan, Syria, and Southern Algeria). In Africa it is practiced
in the majority of the continent including Kenya, Nigeria, Mali,
Upper Volta, Ivory Coast, Egypt, Mozambique, and Sudan.

Even though FGC is practiced in mostly Islamic countries, it
is not an Islamic practice. FGC is a cross-cultural and
cross-religious ritual. In Africa and the Middle East it is performed
by Muslims, Coptic Christians, members of various indigenous groups,
Protestants, and Catholics, to name a few.

Definition:

FGC is a term used to refer to any practice which includes
the removal or the alteration of the female genitalia. There
are three main types of FGC that are practiced through the world
: Type I or Sunna circumcision, Type II or excision, and Type
III or infibulation. These three operation range in intensity,
from the "mildness" of Type I, to the extreme Type
III. Type II is a recent addition to FGC. I will explain in
the next sections what each of these practices involve, and
outline some of the short-term and long-term effects that they
have.

Figure 1. Unaltered Female Genitalia

Type I -- Sunna Circumcision

The first and mildest type of FGC is called
"sunna circumcision" or Type I. The term "Sunna"
refers to tradition as taught by the prophet Muhammad. This involves
the "removal of the prepuce with or without the excision
of part or all of the clitoris (See the World
Health Organization definition). Type I is practiced in a
broad area all across Africa parallel to the equator. Fran Hosken
enumerates the following countries: Egypt, Ethiopia, Somalia,
Kenya, and Tanzania in East Africa to the West African coast,
from Sierra Leone to Mauritania, and in all countries in-between
including Nigeria, the most populous one. There are also reports
of Type I taking place in areas of the Middle East such as in
Oman, Yemen, Saudi Arabia and United Arab Emirates.

Figure 1. Type I Circumcision

Type II - Clitoridectomy

The second type of FGC, Type II, involves the partial or entire
removal of the clitoris, as well as the scraping off of the
labia majora and labia minora . This takes place in countries
where infibulation has been outlawed such as Sudan. Clitoridectomy
was invented by Sudanese midwives as a compromise when British
legislation forbade the most extreme operations in 1946.

Figure 2. Type II Circumcision

Map 1. Click on map to
enlarge

Type III - Infibulation or Pharaonic
Circumcision

The third and most drastic type of FGC is Type
III. This most extreme form, consists of the removal of the clitoris,
the adjacent labia (majora and minora), and the joining of the scraped
sides of the vulva across the vagina, where they are secured with
thorns or sewn with catgut or thread. A small opening is kept to
allow passage of urine and menstrual blood. An infibulated woman
must be cut open to allow intercourse on the wedding night and is
closed again afterwards to secure fidelity to the husband. Hosken
also reports that infibulation is "practiced on all females,
almost without exception, in all of Somalia and wherever ethnic
Somalis live (Ethiopia, Kenya and Djibouti). It is also performed
throughout the Nile Valley, including Southern Egypt, and all along
the Red Seas Coast.

FGC is mostly done in unsanitary conditions in which a midwife
uses unclean sharp instruments such as razor blades, scissors,
kitchen knives, and pieces of glass. These instruments are frequently
used on several girls in succession and are rarely cleaned, causing
the transmission of a variety of viruses such as the HIV virus,
and other infections. Antiseptic techniques and anesthesia are
generally not used, or for that matter, heard of. This is akin
to a doctor who uses the same surgical instrument on a number
of women at the same time without cleaning any of them. (View
Map of Areas of Practice for Type III)

Figure 2. Type III Circumcision

Map 1. Click on map to enlarge

Effects of Female Genital Cutting:

Beyond the obvious initial pains of the operations,
FGC has long-term physiological, sexual, and psychological effects.
The unsanitary environment under which FGC takes place results in
infections of the genital and surrounding areas and often results
in the transmission of the HIV virus which can cause AIDS. Some
of the other health consequences of FGC include primary fatalities
as a result of shock, hemorrhage or septicemia. In order to minimize
the risk of the transmission of the viruses, some countries like
Egypt made it illegal for FGC to be practiced by any other practitioners
than trained doctors and nurses in hospitals. While this seems to
be a more humane way to deal with FGC and try to reduce its health
risks, more tissue is apt to be taken away due to the lack of struggle
by the child if anesthesia is used.

Long-term complications include sexual frigidity, genital malformation,
delayed menarche, chronic pelvic complications, recurrent urinary
retention and infection, and an entire range of obstetric complications
whereas the fetus is exposed to a range of infectious diseases
as well as facing the risk of having his or her head crushed in
the damaged birth canal. In such cases the infibulated mother
must undergo another operation whereby she is "opened"
further to insure the safe birthing of her child.
Girls undergo FGC when they are around three years old, though
some of them are much older than that when they undergo the operation.
The age varies depending on the type of the ritual and the customs
of the local village or region.

Justifications:

In various cultures there are many "justifications"
for these practices. A girl who is not circumcised is considered
"unclean" by local villagers and therefore unmarriageable.
A girl who does not have her clitoris removed is considered a great
danger and ultimately fatal to a man if her clitoris touches his
penis.

One of the most common explanations of FGC is local custom. Women
are often heard saying that they are unwilling to change these
customs since they have always done it this way and are not about
to change. Oftentimes the practitioners are kept ignorant of the
real implications of FGC, and the extreme health risks that it
represents.

Family honor, cleanliness, protection against spells, insurance
of virginity and faithfulness to the husband, or simply terrorizing
women out of sex are sometimes used as excuses for the practice
of FGC.

Some people believe that FGC is a barbaric practice done to girls
and women in some remote villages in foreign countries of the
world. However, up until a few decades ago, it was still believed
that the clitoris is a very dangerous part of the female anatomy.
Who can forget S. Freud who stated in one of his books entitled
Sexuality and the Psychology of Love that the "elimination
of clitoral sexuality is a necessary precondition for the development
of femininity."

As recently as 1979, the "Love Surgery" was performed
on women in the United States. Dr. James E. Burt, the so-called
Love Surgeon, introduced "clitoral relocation" (i.e.
sunna circumcision) to the medical establishment. He believed
and acted upon the idea that excision does not prevent sexual
pleasure but enhances it. Dr. Burt practiced in Ohio for almost
ten years before he was exposed after which he gave up his license.

Because of the large number of cases of FGC and some of the deaths
it has caused, FGC is now outlawed in some European countries
(Britain, France, Sweden, and Switzerland) and some African countries
(Egypt, Kenya, Senegal).

Medicalization

There has been a movement in the last ten years
to perform circumcision in hospitals where the conditions are much
more sanitary, and anesthesia can be used. However, this allows
for the removal of more tissue because the girl is not struggling
as much.

Alternative Rituals

In many cultures, FGC serves as an initiation
rite, and any efforts to eradicate it must take this into consideration.
Some of the most successful eradication efforts have taken place
in areas where FGC was replaced with "initiation without cutting"
programs whereas a girl still goes through some initiation rites
but this time, without any blood.

Alternative rituals are currently being implemented in countries
like Ghana and Kenya, that do not include any bloodletting. A
girl will still undergoes the celebrations and the rituals that
usually accompany the circumcision ritual , however, the procedure
itself is either replaced with a small pricking elsewhere on the
body to let out a small drop of water, or bloodletting is completely
done away with.

Other successful programs have also experimented with giving
midwives monthly salaries for putting down their knives and becoming
health care workers. They are now trained in various aspects of
female health, and go from village to village educating women
about the harmful effects of female circumcision, and the importance
of proper nutrition during pregnancy, how to protect from sexually
transmitted diseases and HIV, and proper usages of condoms, among
other health topics.

Eradication:

It is also important to note that even though
FGC is currently illegal in many countries in Africa and the Middle
East, this has not reduced the number of the girls that are mutilated
every year. The governments of these countries have no way of monitoring
the spread and practice of FGC. The United Nations, UNICEF, and
the World Health Organization has considered FGC to be a violation
of Human Rights and have made recommendations to eradicate this
practice. However, trying to fight FGC on legal terms is ineffective
since those who practice it oftentimes do not report it. FGC is
also widely practiced in villages and remote places where the government
does not have an easy access.

A better and more effective approach would be a cooperation on
the national level as well as the international level. The UN
and the WHO have already taken the first step in abolishing these
practices. Countries also need to have rigid laws that deal with
FGC cases. This is also insufficient by itself. Anthropologists,
educators, social scientists, and activists have to go into these
villages and areas and educate the practitioners of the dangers
of FGC. Female Genital Cutting can only be abolished by a grassroots
approach which would take into consideration all aspects of a
particular culture and try to work within that system of beliefs
to eradicate this practice.

In the United States level, there are many efforts that are being
made in order to abolish the practice locally and internationally.
The National Organization of Circumcision Information Resource
Centers (NOCIRC), a networking organization have brought together
social scientists and medical practitioners from all over the
world who are fighting FGC as well as male circumcision. NOCIRC
has also founded the FGC Awareness and Education Project in August
1996. One of the goals of the project is to create an FGC Module
which will provide information and training material to health
care professionals. NOCIRC has also organized the International
Symposium on Sexual Mutilations.

On the National Level, Congresswoman Patricia Shroeder introduced
H.R. 3247, a bill to outlaw FGC in the United States in the fall
of 1994. The bill was then combined with The Minority Health Initiatives
Act, H.R.3864. This bill was then combined with H.R. 941 on February
14, 1995 which was to be cited as the "Federal
Prohibtion of Female Genital Mutilation of 1995." The
bill was passed in September 1996.

Some overdue effort is being made to abolish FGC, but there is
still much work to be done. Education of ourselves, as well as
of others is a way that we can begin acting upon the convictions
that human rights should not violated, and that violence against
women is intolerable. Many people are still unaware that practices
such as FGC are still widely practiced, and only an awareness
can bring this inhumane practice to a halt.

"Fire Eyes": A
documentary film directed by Soraya Mire, a Somalian woman who's
undergone FGM as a young girl.

"Rites": A documentary film by the American
Anthropological Association (AAA) which also outlines the harmful
effects of FGM.

"Female Circumcision: "Beliefs and
Misbeliefs": Filmed in Africa, this film shows FGM being
performed in a city street and rural areas, interviews villagers
about the reasons/myths surrounding FGM, and depicts educational
efforts to eradicate FGM